Transcript Chapter 3
INTRODUCTION TO CLINICAL PSYCHOLOGY, THIRD CANADIAN EDITION by John Hunsley and Catherine M. Lee Chapter 3 Overview • Questions • Introduction to categorization • Defining normal and abnormal behaviour • The DSM system • The ICD system • Limitations of diagnostic systems • For next class Categorization: in groups of 5-6 (10 minutes) • In the last month what categorizations have you made? • When you informally categorize people, what are the salient characteristics? • Are those similar or different from the ways your parents categorize people? Introduction: Categorization • In the last week in what way have you rated or categorized people? Validity • does the classification scheme capture the nature of the entity? Utility • How useful is the classification scheme Purposes of a diagnostic classification system • Concise description • Common language used by trained professionals • May contain information about etiology, comorbidity, and prognosis • For searching for treatment • For reimbursement of costs of services Defining normal and abnormal behaviour • Psychology includes the study of the range of normal behaviour, thoughts, and feelings – How does a particular phenomenon develop? – What facilitates it or gets in the way? – What is the extent to which it varies in the population In which courses have you learned about the range of what is normal? Definitions of normality • Developmental phase – e.g., Asking for a hug, • Culture – Independence – Sense of time – Respect – Overt expression of feelings • Prevailing norms – Slavery – Wife-beating – Homosexuality Developmental psychopathology approach • Focuses on milestones in development • Developmental tasks at each stage • Heavy focus on infancy and childhood, but growing literature on other phases Research on vulnerability to mental disorder Absence of or disruption of protective factors Biological vulnerability Exposure to stressors Research on vulnerability following disaster • Disaster disrupts ongoing services • Majority do NOT develop PTSD • Those with pre-existing disorders, are at greatest risk Tracking vulnerability to depression • Sutin et al. (in press). Study started in 1958 – 2300 adults – Depressive symptoms highest in young adulthood – Decrease in middle adulthood – Rise again in older adults Diagnosis: definition of problem Physical disorders Mental disorders • Based on cluster of symptoms • Based on cluster of symptoms • Often focuses on clear etiological path • Etiology less clear • Often confirmed by marker identified in X-ray, lab test, or scan • No clear physical markers for most disorders (except some neurological conditions) DSM 1952 DSM-II 1968 DSM-III/III-R DSM-IV/IV TR 1994/2000 1980/1987 DSM-5 2013 Evolution of DSM • 1: largely psychodynamic description – Limited impact on treatment as there was only one type commonly available • 2: more precision – Greater choice among treatments • 3: Atheoretical; behavioural descriptors; focus on inter-rater reliability • 4. Scientifically informed via work groups & literature reviews • 5. Expanded. Consultation. Unprecedented criticism Concerns about DSM-5 • Lack of openness: Confidentiality agreement • Over-representation of biological views • 70% of Task Force members with links to pharmaceutical companies • Poor reliability of diagnoses Reactions to DSM-5 • Open letters from – American Psychological Association – British Psychological Society – American Family Therapy Association • Medicaid & Medicare billing in the United States use ICD • National Institute for Mental Health: – concerns about validity – encourage efforts to develop new system Two basic approaches to classification schemes • Categorical • Dimensional – You have or do not have the diagnosis – You have more or less of the characteristic – Traditional approach in classifying adults dating back to Emil Kraepelin – Common approach in assessing children derived from the work of Thomas Achenbach DSM-5 • Categorical in diagnosis • Dimensional in the way it is organized: e.g., Selective mutism now part of the anxiety disorders DSM-5 • Neurodevelopmental disorders – Intellectual disabilities; Autism spectrum disorders; ADHD • Schizophrenia 77777yyspectrum and other psychotic disorders • Bipolar and related disorders • Depressive disorders – Major depressive disorder; Pre-menstrual dysphoric disorder • Anxiety disorders • Obsessive compulsive and related disorders • Trauma and stress-related disorders • Dissociative disorders DSM-5 (cont’d) • Somatic symptom and related disorders • Feeding and eating disorders • Elimination disorders • Sleep-wake disorders – Insomnia, Central sleep apnea; Restless legs syndrome • Sexual dysfunctions • Gender dysphoria • Disruptive, impulse control and conduct disorders • Substance-related and addictive disorders DSM-5 (cont’d) • Neurocognitive disorders • Personality disorders • Paraphilic disorders • Other mental disorders – Mental disorder due to medical condition; unspecified mental disorder • Medication-induced movement disorders and other adverse effects of medication • Other conditions that may be a focus of clinical attention – Relational problems; Abuse and neglect; Education and occupational problems DSM-5 • More than a list of diagnoses and diagnostic criteria • Syntheses information on prevalence, comorbidity, course, etc… • How to keep all this information current? Allen Frances: Saving normal • http://www.youtube.com/watch?v=-AMvrcBvYWk International Statistical Classification of Diseases and related Health Problems (ICD) • Published by World Health Organization • http://apps.who.int/classifications/icd10/browse/2010/en • Covers ALL health conditions, including mental & behavioural disorders The Big 2 DSM ICD • American Psychiatric Association • World Health Organization • English • 42 languages • Mental and behavioural disorders • All health disorders • Major revenue for APA • Available free on-line • Provides information on disorder • Diagnostic criteria only • Used to assess prevalence ICD-10-Clinical modification • As of October 2014 will be used by US Department of Health and Human Services • ICD-10 CM is compatible with DSM-5 for many disorders • Differences between the two systems (e.g., Acute stress reaction) • ICD-11 due to be released in 2015 ICD-10 • Organic mental disorders (includes Alzheimer’s) • Mental and behavioural disorders due to psychoactive substance use • Schizophrenia, schizotypal, and delusional disorders • Mood (affective) disorders • Neurotic, stress-related and somatoform disorders (e.g., OCD, PTSD) • Behavioural syndromes associated with physiological disturbances and physical factors (e.g., eating disorders). • Disorders of adult personality and behaviour. ICD-10 (cont’d) • Mental retardation • Disorders of psychological development (e.g., language disorder, autism) • Behavioural and emotional disorders with onset usually occurring in childhood and adolescence (e.g., ADHD, CD, separation anxiety disorder) Challenges in diagnosis • Keeping up with the science • Medicalization of ordinary life • Inadequate reliability Challenges in diagnosis • Keeping up with the science • Medicalization of ordinary life • Inadequate reliability • Polythetic nature of disorders—people with the same dx may show it in very different ways • Low validity • Comorbidity For next class… Copyright Notice Copyright © 2014 John Wiley & Sons Canada, Ltd. All rights reserved. Reproduction or translation of this work beyond that permitted by Access Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requests for further information should be addressed to the Permissions Department, John Wiley & Sons Canada, Ltd. 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